Ribociclib and Chemoembolization in Treating Patients with Advanced Liver Cancer

Inclusion Criteria

• Histologically confirmed diagnosis of hepatocellular carcinoma (mixed HCC/cholangiocarcinoma is allowed)
• Retinoblastoma protein (RB) positivity as defined by RB expression (score of 0.5 or 1) with concurrent p16in4a loss (score of 0-2)
• Patients must have HCC limited to the liver; there must be no definitive clinical or radiographic evidence of extrahepatic HCC; portal lymphadenopathy is permitted as lymphadenopathy is commonly associated with cirrhosis unrelated to malignancy
• Absence of occlusive main portal vein thrombus, branch venous thrombus is allowed
• Patients with locally advanced HCC not eligible for curative therapies
• Child-Pugh score A or B7
• Eastern Cooperative Oncology Group (ECOG) performance score of 0-2
• Anticipated life expectancy greater than 6 months
• Total bilirubin =< 2.0 x upper limit of normal (ULN) or direct bilirubin =< 1.5 x ULN in patients with well-documented Gilbert’s syndrome
• International normalized ratio (INR) = 1.7
• Hemoglobin (Hgb) >= 9.0 g/dl
• Alkaline phosphatase < 5 times ULN
• Aspartate aminotransferase (AST) < 5 times ULN
• Alanine aminotransferase (ALT) < 5 times ULN
• Platelet count >= 75,000/mm^3
• Serum creatinine =< 1.5 mg/dL or creatinine clearance >= 50 mL/min
• Absolute neutrophil >= 1,500 cells/mm^3
• Potassium, total calcium (corrected for serum albumin), magnesium, and phosphorus within normal limits for the institution or corrected to within normal limits with supplements
• Women of childbearing potential must have a negative pregnancy test
• Prior therapy is allowed provided the following are met: at least 4 weeks since prior locoregional therapy including surgical resection, radiotherapy, or ablation; provided target lesion has increased in size by 25% or more or the target lesion was not treated with locoregional therapy

Exclusion Criteria

• Patient who received any CDK4/6 inhibitor
• Patient who has received previous systemic therapy or transarterial chemoembolization (TACE) for HCC
• Clinically significant, uncontrolled heart disease and/or recent events including any of the following: * History of acute coronary syndromes (including myocardial infarction, unstable angina, coronary artery bypass grafting, coronary angioplasty, or stenting) or symptomatic pericarditis within 12 months prior to screening; * History of documented congestive heart failure (New York Heart Association functional classification III-IV); * Documented cardiomyopathy; * Patient has a left ventricular ejection fraction < 50% as determined by multi-gated acquisition (MUGA) scan or echocardiography (ECHO) at screening; * History of any cardiac arrhythmias, e.g., ventricular, supraventricular, nodal arrthymias, or conduction abnormality within 12 months of screening; * Bradycardia (heart rate < 50 at rest), by electrocardiography (ECG) or pulse, at screening; * Congenital long QT syndrome or family history of long QT syndrome; * Systolic blood pressure (SBP) > 160 or < 90 mm Hg
• On screening inability to determine the corrected QT using Fridericia's formula (QTcF) interval on the ECG (i.e.: unreadable or not interpretable) or QTcF > 450 msec (using Fridericia’s correction); all as determined by screening ECG (mean of triplicate ECGs)
• Patient is currently receiving any of the following medications and cannot be discontinued 7 days prior to treatment: * Known strong inducers or inhibitors of CYP3A4/5 or bile salt pump efflux, including grapefruit, grapefruit hybrids, pummelos, star-fruit, and Seville oranges; * That have a known risk to prolong the QT interval or induce torsades de pointes; * Herbal preparations/medications, dietary supplements; * That have a narrow therapeutic window and are predominantly metabolized through CYP3A4/5
• Tumor involvement > 50% of the liver
• Patient has a known history of human immunodeficiency virus (HIV) infection (testing is not required)
• Patient has any other concurrent severe and/or uncontrolled medical condition that would, in the investigator’s judgment, cause unacceptable safety risks, contraindicate patient participation in the study or compromise compliance with the protocol (e.g. chronic pancreatitis, active untreated or uncontrolled fungal, bacterial, or viral infections, etc.)
• The following uses of corticosteroids are permitted: single doses, topical applications (e.g.: for rash), inhaled sprays (e.g.: for obstructive airways diseases), eye drops or local injections (e.g.: intra-articular)
• Patient is currently receiving warfarin or other Coumadin-derived anticoagulant for treatment, prophylaxis or otherwise; therapy with heparin, low molecular weight heparin (LMWH) or fondaparinux is allowed
• Participation in a prior investigational study within 30 days prior to enrollment or within 5 half-lives of the investigational product, whichever is longer
• Patient who has received radiotherapy =< 4 weeks or limited field radiation for palliation =< 2 weeks prior to starting study drug, and who has not recovered to grade 1 or better from related side effects of such therapy (exceptions include alopecia) and/or in whom >= 30-25% of the bone marrow was irradiated
• Patient has had major surgery within 14 days prior to starting study drug or has not recovered from major side effects (tumor biopsy is not considered as major surgery)
• Patient has not recovered from all toxicities related to prior anticancer therapies to National Cancer Institute (NCI)-CTCAE version 4.03 grade < 1 (exception to this criterion: patients with any grade of alopecia are allowed to enter the study)
• Patient has a known hypersensitivity to any of the excipients of LEE011
• Prior ablative, radiation, resection, or transplant therapies less than 4 weeks before study registration
• Active gastrointestinal bleeding
• Allergy to iodine or gadolinium contrast that cannot be safely controlled with premedication
• Concurrent malignancy or malignancy within 3 years of study entry, with the exception of adequately treated basal or squamous cell carcinoma, non-melanomatous skin cancer or treated cervical cancer
• Contraindication to angiography or chemoembolization medications
• Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after contraception and until the termination of gestation, confirmed by a positive hCG laboratory test
• Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception throughout the study and for 8 weeks after study drug discontinuation; highly effected contraception methods include: * Total abstinence when this is in line with the preferred and usual lifestyle of the patient; periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception * Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy) or tubal ligation at least six weeks before taking study treatment; in case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment * Male sterilization (at least 6 months prior to screening); for female patients on the study, the vasectomized male partner should be the sole partner for that patient * Combination of any of the two following (a+b or a+c or b+c) ** Use of oral, injected or implanted hormonal methods of contraception or other forms of hormonal contraception that have comparable efficacy (failure rate < 1%), for example hormone vaginal ring or transdermal hormone contraception; ** Placement of an intrauterine device (IUD) or intrauterine system (IUS); ** Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/ vaginal suppository in case of use of oral contraception, women should have been stable on the same pill before taking study treatment * Note: Oral contraceptives are allowed but should be used in conjunction with a barrier method of contraception; women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks ago; in the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential
• Sexually active males, unless they use a condom during intercourse while taking the drug, and for 21 days after stopping treatment of LEE011 -- should not father a child in this period; a condom is required to be used also by vasectomized male in order to prevent delivery of the drug via seminal fluid
• Any physical condition that can prevent ability to tolerate oral therapy